O

7018 Employer’s Order Blank for Forms Form

 Please send your order to IRS as soon as possible

(Rev. August 2004)

Department of the Treasury

Internal Revenue Service

Item

W-4 S

W-2 C

W-2 G

941 SCH B

W-3

W-3 C

W-4

W-4 P

941

1099 B

943 A

1096

1099 A

1099 S

1099 DIV

1099 INT

1099 MISC

1099 LTC

1099 PATR

1099 R

5498

Pub 213

Pub 1494

Quantity

1099 C

945

945 A

W-2 Wage and Tax Statement

Corrected Wage and Tax Statement

Certain Gambling Winnings

Transmittal of Wage and Tax Statements

Transmittal of Corrected Wage and Tax

Statements

Employee’s Withholding Allowance

Certificate (2004)

Withholding Certificate for Pension or

Annuity Payments

Request for Federal Income Tax

Withholding From Sick Pay

Earned Income Credit Advance

Payment Certificate

Employer’s Record of Federal Tax

Liability

Supporting Statement To Correct

Information

Agricultural Employer’s Record of

Federal Tax Liability

Annual Return of Withheld Federal

Income Tax

Annual Record of Federal Tax Liability

Annual Summary and Transmittal of

U.S. Information Returns

Acquisition or Abandonment of

Secured Property

Proceeds From Broker and Barter

Exchange Transactions

Cancellation of Debt

Dividends and Distrib

Interest Income

W-5

Miscellaneous Incom

1099 OID

5498 SA

1099 SA Distributions From H

or Medicare+Choice 

Long-Term Care and 

Death Benefits

Original Issue Discou

Taxable Distributions 

Cooperatives

Distributions From P

Retirement or Profit-

IRAs, Insurance Con

Proceeds From Real 

Transactions

IRA Contribution Info

HSA, Archer MSA, o

Medicare+Choice MS

Check Your Withhold

Table for Figuring Am

From Levy On Wage

Other Income (Forms 

668-W(c)(DO))

Title

Instructions. Enter the quantity next to the form you are ordering. Please order the number of forms needed, n

sheets. Note: None of the items on the order blank are available from the IRS in a continuous-feed version. All f

blank that require multiple copies are carbonized so that you will not have to insert carbons. You will automa

instruction with any form on this order blank. Type or print your name and complete mail delivery address in t

below. An accurate mail delivery address is necessary to ensure delivery of your order.

Employer’s Annual Federal Tax Return

for Agricultural Employees 943

Quantity Item Titl

941 C

Employer’s Quarterly Federal Tax

Return

1098 E Student Loan Interest Statement

Use This Portion For

2005 Forms Only

Postal Mailing Address

W-4

W-4 P

City

W-4 S

W-5

Foreign Country

(2005 Revisions)

QUANTITY

Company Name

Visit the IRS website @ www.irs.gov.

International 

State 

Daytime Tele

USE THIS PORTION FOR 2004 FORMS ONLY

Cat. No. 43708F

1098 T Tuition Statement

1098 Mortgage Interest Statement

1099 G Certain Government 

Attention:

Ste/Room

( )

1099 Q Payments From Qua

Programs (Under Sec

5498 ESA Coverdell ESA Contr

Information

1099 CAP Changes in Corporat

Capital Structure

1099 H Health Coverage Tax 

Advance Payments
Send your order to the Internal Revenue Service address for

the Area Distribution Center closest to your state.

Where To Send Your Order

Central Area Distribution Center

P.O. Box 8908

Bloomington, IL 61702-8908

Western Area Distribution Center

Rancho Cordova, CA 95743-0001

Eastern Area Distribution Center

P.O. Box 85075

Richmond, VA 23261-5075

The time needed to complete this form w

on the individual circumstances. The estima

is 3 minutes. If you have comments concer

of this time estimate or suggestions for mak

simpler, we would be happy to hear from yo

to the Internal Revenue Service, Tax Produc

Committee, SE:W:CAR:MP:T:T:SP, 1111 Co

NW, Washington, DC 20224.

Please do not send your order Form 701

Products Coordinating Committee. Send yo

the IRS Area Distribution Center closest to 

You are not required to provide the inform

on a form that is subject to the Paperwork 

unless the form displays a valid OMB contr

or records relating to a form or its instructio

retained as long as their contents may beco

the administration of any Internal Revenue l

returns and return information are confident

Code section 6103.

Paperwork Reduction Act Notice. We ask 

information on this form to carry out the Int

laws of the United States. Your response is